Thank you for standing by. Welcome to the ImpediMed Limited Quarterly Results Conference Call and Investor Presentation. All participants are in a listen-only mode. There will be a presentation followed by a question-and-answer session. If you wish to ask a question, you'll need to press the star key followed by one on your telephone keypad. I'll now like to hand the conference over to Mr. Richard Valencia, Managing Director and Chief Executive Officer. Please go ahead.
Thank you, Winnie, and welcome everybody to our third quarter 4C and investor presentation. We've got some good updates for you. We've got three key updates that we wanna cover today. First of all, as we talked about a few weeks ago, the NCCN survivorship guidelines were updated very favorably for us. That has turned into a very transformative moment for the company in a number of ways, and we're gonna get into a little bit more detail as to how after we give you a third quarter update in a few minutes. We're also achieving significant momentum with payers in the U.S.
We talked a bit about that. I believe some folks were a bit frustrated that we couldn't give you a little bit more detail around the pace at which payers would respond to the guidelines and begin reviewing their medical policies and actually making changes. We didn't know. It really is something that you can't know until you witness what's going on in the real world in reaction to the guidelines. The good news is in the last three weeks, it was only on March twenty-fourth when the guidelines came through just over three weeks ago, we've seen significant traction with the payers. I'll get into the details of that in a little bit, but we're really excited with the pace at which they have reacted and are engaging in medical policy reviews.
I intentionally chose to be conservative about the approach last time. Company has a bit of a history of not being able to follow some of the promises that it's made. This is early on for me, been with the company just over 120 days now, and I wanted to set the stage that going forward, we're gonna be very intentional about what we read out to the market, and I wanna lead with facts. We've come back with facts around how the payers have responded, and I think you're gonna be real happy. The survivorship guidelines as they are written has really dramatically impacted our total addressable market in a very good way.
We have mentioned already that the survivorship guidelines apply to all patients at risk of lymphedema, all cancer patients, that has opened the door for us to pursue other cancer types. The reimbursement alone has increased the amount that we believe we can charge 'cause the economic model for our customers has significantly improved as a result of reimbursement. We'll get into a little more detail there as well. Those are the three key points we wanna cover today. On the first point, the highly transformational piece of this. We talked a lot already about the guidelines themselves and why that's transformational. As a company, we're going through a pretty significant transformation as well.
When I came into the business, I observed a company that wasn't functioning at the level that I felt we needed to really succeed in a market that was developing, especially if we got these guidelines to be a market that we could own if we were prepared to execute on it and work as a really good team. We worked on it actually, timing-wise, just after the guidelines, the following week, we had an off-site with the team. We focused on three things in that off-site. What's our purpose? Why are we here? What's our North Star or our vision? How do we create an unbeatable team? I believe that if you create the right team dynamic with your senior leaders, you can create a competitive advantage that really gives you a leg up on competitors.
It's something that's really at my core that I work very hard at, and I saw that the team needed that sort of leadership and that sort of approach, and the response has been phenomenal. Also, how do we operationally transform the business to be able to scale with this great opportunity that we have given the readout and the guidelines? On slide four, we have our reimagined vision, and I'm gonna read it. "Transform medicine by providing clinically relevant insights that improve lives." We spent a lot of time with that, and it's very intentional. In the deck, I've actually put the definitions of the three key terms there. Transform or change something completely and suddenly so that it's much better.
The guidelines, as they're written, will enable us using our bioimpedance spectroscopy technology or SOZO to completely and suddenly change lymphedema care for cancer patients and help avoid lymphedema entirely. Clinically relevant, the ability of a therapy to improve how a patient feels, functions, and/or survives. Clearly, if we can help avoid lymphedema, we can help improve patient lives. Finally, insights, the capacity to gain an accurate and deep intuitive understanding of a person or a thing. Our SOZO platform is all about capturing data, delivering it back to the patient at the point of care, but also having that data with our digital health platform to continue to build into build new features into our solution and move into other cancer types over time.
We spent a lot of time with this vision, and we've got a team now that's very focused on this and very bought into our new vision for the company. The other two things around the team and around execution. I'm a big believer in the book, The Five Dysfunctions of a Team. It's sort of my team-building Bible that I bring with me everywhere. My favorite quote is, "Not finance, not strategy, not technology. It's teamwork that remains the ultimate competitive advantage, both because it's so powerful and so rare." Those last two words are really powerful. It's so rare. It really is rare to create a team dynamic where people are truly working with one another, helping one another out and really focused on results.
The team, when I came in, was much more oriented towards building new technology, identifying new market opportunities for that technology, but not very, certainly not very commercially oriented, and we did not have a lot of discipline around execution. My focus is going to be in creating a great team that believes in that and then creating the methodology that we'll use to ensure that when we make commitments to the market, we make commitments to our board, we're gonna track those commitments and we're gonna live up to them. That gets us to focused execution. Focused execution means two things. One, given the guidelines, given the mention that it's for all cancer patients at risk of lymphedema, this has just really blown up our opportunity within oncology.
As you know, we've got a very good footprint already in a lot of the best cancer centers around the country in the U.S. It would be foolish for us to do anything but execute within oncology for the next several years because we have a license to go in and it's ours and ours only. There's no competition that can do what we can do in survivorship around lymphedema. We're gonna be focused on breast cancer-related lymphedema initially, but then moving out into other cancer types for the next few years. We're not giving up on heart failure, we're not giving up on renal, we're not giving up on other opportunities that our SOZO platform can deliver on.
Our primary focus is going to build the foundational business in oncology and make sure we lock down every cancer center we possibly can, 'cause once you're in in healthcare and you're delivering a great solution like we have, we don't think we can be unseated. The other part of focused execution is again around the team and how we operate. I leverage a tool called four Disciplines of Execution, where we get really focused on a number of high-level goals for the company, and then we track leading indicators, the things that we do on a day-to-day basis to ensure that we'll reach that end objective. Everything else is white noise. You know, we deal with it in our separate time, but our daily focus is around our key company objectives.
You're gonna see us being much more disciplined, especially as we move into this commercial deployment around the guidelines. A lot of things have to change for us to live up to the scale that's about to come, so that's where we're gonna be focused. I'm gonna come back and give you a little bit more detail in a few minutes, but now I'm gonna turn it over to Tim, who will share our Q3 results. Tim, take the stage.
Great. Thanks, Rick. Good morning, everyone. For this quarter's presentation, we want to get into the meat of the result or meat of the information related to reimbursement. We boiled the financial slides down into three key slides. It's related to revenue, SaaS metrics, and cash flow. On slide six, the key here is the continued incremental growth in the core business. Core SaaS revenue grew by 25% year-over-year on a constant currency basis. With the NCCN guidelines update announced just a few days prior to the end of the quarter on the 24th of March, there's no impact in the quarterly results related to this transformative development for the company. Therefore, the incremental growth in the core business and the slight decline in total revenue were broadly in line with the expectations that we had in a pre-reimbursement environment.
The decline in total revenue was primarily due to the timing of international SOZO sales, which was largely offset by the incremental growth we saw in recurring revenue from the core business. As we go through on later slides, the continued incremental growth ensures that we maintain our footprint in key cancer centers, and that's the key. During the period, we went from having 20-22 NCCN institutions utilizing SOZO. We went up to 17 of the top 25 IDNs. Within a vast number of these centers, we have IT and legal clearance at a corporate level, as well as established Business Associate Agreements and even pricing.
Our foothold in maintaining these key centers as we build reimbursement now offers us access to over 10,000 sites of service that we can begin to go after with an expectation that take-up of SOZO will rapidly accelerate as private payers now come on board in the coming quarters, which Rick will get into in his slide. We turn to slide seven, the strength of our renewals and our continued low churn are two of these key fundamentals for the business and strong drivers of growth. For the fourth consecutive quarter, we achieved 30%+ increases in the renewal license fees on U.S. contracts. This has been achieved in a world prior to the NCCN guidelines inclusion and prior to private payer reimbursement. With the NCCN guidelines inclusion, these increases will accelerate as private payers now come on board.
We signed AUD 3.2 million in total contract value during the period, which related entirely to our core business. ARR grew to AUD 9.2 million, of which AUD 8.7 million relates to the core business. That's a 15% increase year-over-year. As we've noted for a number of quarters now, our stair-step pricing model locks in price increases year-over-year. That same AUD 8.7 million in ARR is worth AUD 10.2 million in one year's time prior to selling any new SOZO devices, systems, I should say. In addition, we continue to maintain in excess of 90% gross margins on our Saas revenue business and a negligible churn rate of 2%. Slide eight, finishing up with cash flow. The cash flow result for Q3 FY 2023 was very positive.
As outlined in last quarter's cash flow guidance, net operating cash flow was below AUD 3 million for the quarter, coming in at AUD 2.79 million. That was a result of us now seeing the impact of the recent cost realignment come through in the numbers, as well as a record result for cash receipts from customers. Q3 FY 2023 resulted in AUD 3.2 million in cash receipts, which is a 25% increase year-over-year. We finished with a cash balance at March 31st, 2023, of AUD 21.4 million, yielding us eight quarters of cash on hand prior to additional growth. As a result, we remain well on track to steadily achieve our objective of cash flow breakeven within our existing capital, and we'll accelerate the business as we see private pay reimbursement now take hold. Rick, back to you.
Thanks, Tim. All right, on slide nine, I'm gonna take you back through the impact of the guidelines just to recenter everybody around what this actually means to us. In the guidelines, first of all, the screening that was recommended is regular screening for patients, and the real key change here is that it's now all patients at risk of lymphedema, not patient-reported, not. The burden now has been shifted to the provider to ensure that patients get regularly tested. We have a Lymphedema Prevention Program that addresses that regular testing. It, that's something that we've been promoting for quite some time. We have a number of customers using that protocol. It just so happens that it fits very well with the recommendations around screening in the guidelines. It specifically names bioimpedance spectroscopy.
Really important, no other device but SOZO, our SOZO system uses bioimpedance spectroscopy that is FDA cleared. You'll hear some noise in the market of other systems that claim to have bioimpedance, but not bioimpedance spectroscopy. One of the things that we'll be doing as we're talking to payers is educating them on bioimpedance spectroscopy technology, what is and what is not, to make sure that in an updated medical policy, that they're very specific around bioimpedance spectroscopy and not including technologies and companies that might attempt to use that reimbursement code. At-risk cancer survivors, again, I mentioned this a little bit ago, that now the providers need to test every patient at risk. The big news there, of course, is that that increased our TAM dramatically, and I'll get into details in just one minute.
Uniform consensus, we've talked about this. The Category 2A is the default category, so virtually all guidelines changes that are approved are in this Category 2A. It means that there was uniform NCCN consensus. It is what payers use to determine whether or not to change medical policy to reimburse. It's what providers use, particularly NCCN providers, leading cancer centers, to determine how they provide care. Finally, it helps us to establish the standard of care. Some people would say guidelines is the standard of care. It's effectively correct. However, until bioimpedance spectroscopy is being used and patients at risk of lymphedema are being tested on a regular basis, and this is being done en masse, it's hard to call it the standard of care.
That's gonna be our work over the next few years, is to make sure that in the in the guidelines it says to use bioimpedance spectroscopy if available. It's our goal to go out and make sure that they've got it so that they can provide the screening for patients. On slide 10, this is the the big reveal slide around the payer response since we last got with you. Again, wasn't sure how quickly they would respond, but in just three weeks, we've been able to get our physician advocates, our customers, people that believe in using bioimpedance spectroscopy for helping patients avoid lymphedema reach out to the payers in the U.S.
We don't do it directly, we do support them, we provide them with some of the tools, some of the terminology that they need to use some of the other bits of evidence that they then bring to the payers to request a medical policy change. They typically don't do out-of-cycle changes unless something very dramatic has occurred. In this case, 45 of them chose to do a review. 42 chose to do it off cycle. Doing an off-cycle review means that they've taken it very seriously. They could simply just wait and decide to do the review of their medical policy when their next annual review comes up. That's how they do most of the potential changes.
The NCCN guidelines are very powerful, and that caused a very quick reaction by these 45 payers to do reviews. The three that are on-cycle reviews, those happen to be between now and the middle of June. Why do an off-cycle review when your on-cycle review's coming up pretty quickly? All of these reviews should be done within the next few months, two or three months. Another really important point about the three on-cycle reviews is that two of them are national payers. National payers doing reviews and changing their medical policy to include bioimpedance spectroscopy for monitoring for lymphedema is going to. It's something that we weren't dreaming of before NCCN.
Our strategy had us working with multiple regional payers and the national ones we put at the end of the list because they're harder to work with, and they need to feel some competitive pressure in the marketplace with the regional payers agreeing to reimburse before they take it seriously. The guidelines changed all that. We're really excited to see that even national payers are moving very quickly. Of these 63 payers that currently have experimental policies, meaning non-coverage, 45 now are going to be doing reviews within the next 2-3 months. 17 we're awaiting on hearing back from. We just haven't heard back, and that doesn't mean that they're not going to do an in-cycle or off-cycle review. In fact, we were putting together our deck on Friday in the U.S.
Before the end of the day, we had to put one more in the bucket of off-cycle reviews because we'd heard from one. We're expecting through the week we'll probably hear more, and it won't be very long before we get feedback from all 17, so a total of all the 63. Moving very quickly. That's the payer update. In terms of the TAM update on the next slide, it'll be slide 11, we've done quite a bit of work digging into what this really means around cancer-related lymphedema going beyond breast cancer-related lymphedema, and also just the impact of the guidelines and the reimbursements that's gonna follow on our ability to charge more and still create a great economic model or ROI for our customers.
We've been reporting out a $600 million TAM for quite some time for breast cancer-related lymphedema. That was based on an average $1,500 a month fee. We're seeing significant increases in that, as Tim mentioned earlier, when we renew our contracts, and we have some as high as $4,000 a month. We believe that just the impact of reimbursement will enable us to get to $2,500 per month on average with our customers as they renew and as we sell new accounts. That extra $2,500 moves our total addressable market in breast cancer-related lymphedema to $1 billion. In addition to that, there...
In these other cancers where the lymphatics are involved and patients become at risk for lymphedema, we believe that we can license the ability to use SOZO for these other cancer types and through that increase our monthly fee to around $4,000. That equates to a $2 billion market, and that's before we even consider additional sites of service. There are cancer types that are contained and will have completely different sites of service than. A good example is gynecologic cancers are generally handled very differently. There are more sites available as well over time. Conservatively, we're thinking this is a $2 billion TAM now.
What we will need to do is we will need to go get data that shows the same impact that we have on breast cancer-related lymphedema in these other cancers. Our systems are in place at the research institutes that can perform the research for us. The N that we need compared to our 1,200 patients that we had in our PREVENT study, that N goes way down. You only need a few hundred typically, and we've already got the systems in place. The path to getting that data to get other cancers approved is relatively short. We're convinced that we've got a much bigger TAM today, and the path to getting to that is relatively short, which is why we believe that we should stay very focused on the oncology market.
I'll explain in the next slide, A little bit more as to why. I do wanna point out one last thing. We've called out the $10 billion market in the U.S. That's the annual cost of lymphedema treatment. That's caring for patients that were not tested clearly, and their lymphedema progressed to stage 3 or 4. That's when it becomes an incurable chronic condition. The treatment market for dealing with this horrible chronic condition is $10 billion. Our $2 billion TAM really is all about going after that $10 billion treatment market and dwindling that as much as humanly possible. On to the next slide, on slide 12. This talks about where we're going to focus and why.
If you take a look at the right-hand side, that's our addressable market. 24,000 plus sites of service in all the cancer types. We currently have 500 SOZOs deployed with the customers that we have today. In that customer base, just within the customer base that we've already got signed, we already have BAAs with, we have a total of 10,000 sites of service available to us. As those customers who currently only have 500 built full programs to be able to surveil their patients at risk of lymphedema, before we go anywhere else, we have 10,000 additional sites of service that we can be going after.
We're currently in, as mentioned several times, 22 of the NCCN institutions, 17 of the top five IDNs or integrated delivery networks in the U.S., and 150 of the top 500 cancer centers. Just those represent 10,000 sites of service. We'll be pushing, first and foremost, into the rest of the NCCN institutions. It's their own guidelines. They'll want to treat according to their guidelines very quickly. That'll be our number one focus. We'll go into the integrated delivery networks. Next, we'll do the rest of the cancer centers. Of course, all the other sites that are available that could be corporate type accounts. Number of different type of accounts that we'll be going after to wrap up this full 24,000.
Again, this is a market that is ours to win or lose. We're the only company that can execute right now into the guidelines as they're stated today. Now it's up to us to prepare ourselves to go take advantage of that opportunity. That gets us to our final slide here, which is summarizing the three key points. Immediate response from payers, as mentioned. It will take a few months, by the way, even though they're doing the reviews, it'll take a few months for them to do their medical policy review internally and make the change and publish the change. There's a period of time also where there has to be a public notice where people can weigh in on it, a 30-day period of time.
That, that will take a little bit of time. However, what we're seeing already is a very rapidly accelerating sales pipeline. Deals in the pipeline today just advanced a huge step. We track our deals in our pipeline with what we call the CLIF process, C-L-I-F, clinical, legal, IT, and finance. You move down the funnel of our pipeline as you get clinical bought in, legal engaged, IT, supporting, and finance, of course, signing off in the end. Knowing that reimbursement is on the way, that finance piece, which is always the hardest. Clinical, we always get by, and they love the technology. Legal and IT, it's just their job. When someone tells them to do it, they do the work. Finance, they're the ones that are the tougher one to get cleared.
Of course, we need to prove that there's an economic model beyond the important patient care piece of it. That's progressed every deal that we have in our pipeline significantly as a result of getting the guidelines and the reaction from the payers. We're also getting a lot of anecdotal data from our sales team. We probed them before we headed out here from the field. They're getting responses to their phone calls in ways that they didn't get before. There's this renewed sense of urgency and interest in deploying SOZO now, in not just our existing customers, but in prospects. Finally, preparing for operational scale. You can imagine a company like ours, we've been pretty thinly stretched resource-wise.
Very focused on managing the cash that we had to move the business to cash flow breakeven. We're still on that path today. We've been able to make some really good adjustments. I had mentioned in the last call that we moved our couple of people around within the organization and brought in someone who used to work for the company, and we've moved our sales team from four people in the field to six. We've got an extra 50% horsepower there in the field already. We're making some other changes in our case assistance program. We have to completely reimagine all of those organizations and get ready for scale. Our sales organization is gonna grow significantly.
Our case assistance program has to morph into more of a market access program, where we're doing less case assistants work and filing appeals for our customers and more just supporting them and how they go about getting reimbursements so that their reimbursement kicks off quickly out of the gate, and they're happy with the ROI for the program. We're moving away from a sort of a disjointed customer support. We have technical support, we have customer support, we have implementation, we have clinical sales support. We're moving that into a customer success organization so that we're all very coordinated and we can help get customers deployed and scaled much quicker. We talked about needing a chief medical officer. We continue to be underway in finding a chief medical officer.
We're building out a medical affairs capability that was very thin as a result of some of the cost reduction measures that we took. We need that to go after these other cancer types as quickly as we possibly can to build the evidence for that. Also, a chief medical officer who can communicate with our clients and payers at the CMO level to help us move forward faster. Ultimately, manufacturing. We've shared with you that we feel pretty confident that we're in a good place right now with inventory and with SOZO Pro coming out next year that will be able to track well. If once things really get going here, we clearly have to prepare ourselves for significant scale in the manufacturing side.
Again, we're reimagining everything, and we're getting the company ready for scale, and we're building a discipline around how we do that so that we're very execution-oriented, tracking everything that we commit to. We wanna do all of that while maintaining our 80+ Net Promoter Score and customer satisfaction. We are off to the races. We've got a lot of work to do and that is it for me for today. We'll go back to Winnie for Q&A.
Thank you. If you wish to ask a question, please press star one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star two. If you're on a speakerphone, please pick up the handset to ask your question. Your first question comes from Shane Storey from Canaccord Genuity. Please go ahead.
Good morning, Tim. Good morning, Rick. Looks like you've recut some of the addressable market assumptions there. If you don't mind, I just want to step through a few of those. Maybe just if we could start with the 24,000-
Yeah.
sites of service. I see that breaking down over 5,600 facilities.
Yeah.
Quite, you know, just over four sites of service per facility. I mean, that's a bit marginal than what we would have anticipated.
Yeah.
Would you say that reflects, I guess, how the 500 SOZO footprint that we have in the field today is distributed?
For the most part, we don't have customers that are doing full programs. They generally are early adopters who really believe in the technology and what it can do to benefit their patients. They've got one or two systems, and they don't use our LPP. They don't really use a protocol. They don't test on a continuous basis as is called out in the new guidelines. Our expectation was always that when we got to that point, that we would end up in surgery, in med onc, in rad onc, rehab PT, and also outpatient. That's five different locations. We're estimating four when people build out real programs. That's how we get to those numbers.
Got it. Like I said, it's just an appreciation of the extra volume there that needs to be processed. When we look at the, when I look at your overall TAM, I guess the new sort of number of $1 billion for breast, and I think $2 billion overall.
Yeah. Yeah.
Traditionally, we all used to model that BCRL has about 25%.
Yeah.
Of the overall TAM based on incidence rates. Here it's kind of 50. I hear what you said about pricing, has anything changed with respect to how you're seeing the other...
Yeah.
the other indications potentially?
Christian Moore has a follow-on. You had some background noise there, Shane, and I didn't quite get the. Did you get mine?
It's still the same data that's being looked at. 15% of the incidence rates are breast. Of that, of the total incidence rates, 58% is all cancers that are relevant to at-risk for lymphedema. Is that your question, Shane?
Yeah, that's perfect, Tim. Finally from me.
Yeah.
Constantly a minute noisy background. The, just on pricing. It's just really a clarification. Can you please confirm that the TAMs there are based on $4,000 a month? 'Cause I noticed there's a slide there of five and a half, and I wonder if you could please explain the circumstances that might support that higher level price.
Yeah. The TAM currently is based on $1,300. As you indicated, we've had $600 million TAM. The new $1 billion TAM is based on a $2,500 a month average. The $2 billion TAM with the other cancers, the assumption is that we can license those other cancers as we develop the data and get reimbursement onto the same systems and increase from $2,500 to $4,000 because now they can use the L-Dex for all those other cancers. We have yet to add additional sites of service that at some point will be upside to this number, but that's how we're getting there right now.
There are some sites that get to $5,500, so that's why it calls out up to $5,000-$5,500. On average, across all cancers, we're modeling $4,000. Thanks. That's very helpful, Tim. That's all I have.
Yeah. Thanks, Tim.
Thank you. Your next question comes from Elyse Shapiro from Canaccord Genuity. Please go ahead.
Congrats on the update. Thanks for taking the question. You've talked to guidance before of a loss of or operating cash burn of AUD 3 million a quarter. Are you kind of maintaining that even with some of the new hires that you're making into medical affairs and the CML?
As of right now, yes, we are.
Yeah. We're learning new things every day about the speed at which reimbursement is going to occur. Our modeling is still based on less than AUD 3 million, and eventually, it'll come down to the pace at which we want to accelerate our growth as we start to learn more and more concrete evidence. With the time it takes for some of these payers to write their policies and then with the different regions that we're gonna learn where we have first access, we should be able to lean into our growth a little bit and fund it through, you know, through the, through the short-term growth that we're seeing before we have to go to full scale.
Okay.
The type of work that we. Elyse, I'm gonna jump in real quick. The type of work that we need to do in order to be ready for scale, it's not the type of thing you can wait until you're seeing high demand and closing deals at a much more rapid pace because we'll get overwhelmed. We are going to have to be thinking about how we invest, how we re-orient our investment and how we're ready for that scale. We're not ready today for that scale. We've got a lot of work to do in terms of getting the right types of resources in place to manage the level of scale that I expect to see soon.
Great. Thanks. It looks like you've been making some progress on the payer side. You know, you talked to, I think it was, you said two national payers. Can you give a bit more color around the profile of some of those other payers in terms of, you know, covered lives, or specific geographies?
Well, the If we had the 42 come back and make positive medical policy changes, we would be in a place where we have critical mass coverage in almost every state in the union. We actually just had this conversation with our head of reimbursement yesterday. We Getting these 45 over the top on changing their medical policy it'll actually. The context that it came up in when we had the conversation with her is around our original focus on seven markets. We still have momentum there. We've got the right clinical advocates there. We've got the NCCN institutes there. With the guidelines and reimbursement coming around so quickly, it's sort of non-operative any longer.
That isn't necessarily where we need to focus because what's gonna happen as these 45 start changing medical policy is that we're gonna see broad-based coverage that has reached that threshold in multiple states all around the country. We're just gonna focus where it happens first. You know, we still have real high hopes that Michigan, Tennessee, those were some of the early focused markets, are gonna probably go first. Now it's really going to just be watching how it plays out and where we get to critical mass fastest, and that's where we'll put our sales effort.
Great, thanks. you know, I know it hasn't been a huge amount of time since the guideline inclusion, but are we starting to get more inbounds from doctors, hospitals, or even sort of patient advocacy groups?
You bet. Yeah. It's a very different world since the guidelines have come out. Just there's a buzz, if you will, in the market. We're actually going to be at the ASBS conference week after next, and they're very excited to have us there. There's a lot of discussion that's going to be going on there around the updated guidelines. Survivorship, of course, is not the biggest part of a conference like that, but it's really Survivorship, the issue of having these related problems after cancer. You beat cancer and your reward is you end up with lymphedema or some other horrible survivorship issue or side effect. The awareness of survivorship issues is growing quite a bit.
That's why there's quite a bit of survivorship talk there on the agenda. They're gonna be real excited to hear us. Yeah, we're getting a lot of inbound. The sales team's reporting a lot of good, solid communications that are much better than they were before we had the guidelines.
All right. Great. Thank you.
Okay.
Thank you. Your next question comes from Peter Gregory from Private Investor. Please go ahead.
Good morning, or I guess it's probably a different time of day for you guys. Thank you very much for your presentation, and it's really great to hear the update.
I'd like to make a fairly simplified statement about the marketplace, and that is to say that sustainable growth will come from two sets of circumstances. Firstly, placements of new systems which will yield immediate sales. Secondly, from increased usage of already placed systems, which will have a slower impact on revenue, which will demonstrate longer-term commitment from facilities and the practitioners. Could you talk me through how the customer-facing resources have been directed to each activity? Do you have a priority for one or other of these? How is the remuneration of these people structured to reward customer-facing people for each of these activities?
Those are excellent questions, Peter. By the way, we're here in Sydney right now, so we're in the morning as well. Our revenue model is that we charge a subscription. We license our SOZO digital health platform and charge a monthly subscription fee for that. Our customers get paid per test, so they get paid through either Medicare, Medi-Cal, and now private payer reimbursement on a per test basis. Those two are not connected, and it's very deliberate. The reason that we don't wanna have them connected is that we don't want them limiting the number of people that they put on our platform because they're worried of the cost associated with it.
We want them to put as many people as humanly possible onto the platform. We really wanna get the data as much as we possibly can. We want them to treat every patient that's at risk. We, we wanna have a fair share of the remuneration that they'll receive through reimbursement, but that typically runs in the 30%-40% range, and that's roughly where we are right now. We are thinking about over time, putting thresholds.
We think we have a long ways to go before we really have to worry much about that. There might be a time where we see some of the bigger institutions at super high volumes where we will need to put a limit of how many measurements can be done at a $2,500 a month charge, for example. For now, we just charge the monthly fees. We do increase those every time the contract renews, and we're very successful with doing that. I wanted to explain our revenue model first. We have a commercial team that is heavily incented to sell, so their compensation is heavily weighted on the variable side of things.
They get a base pay, but they make their money when they close deals and do system sales. On the customer success side of things or support, we have a very, very high customer satisfaction rating today. It's mostly because they really love the technology and what it does to benefit their patients because it's mostly the clinical side of the shop that works with it, and they're not getting much reimbursement, but they don't care because they really just wanna provide great care to their patients. We get great feedback from them. When I went and visited customers, I saw that very few of them had a real program in place, one that would be able to fully monitor all of their patients.
Part of it was because it, they couldn't afford to buy multiple systems. Part of it was just workflow issues. A big part of it was because we weren't in the guidelines. We weren't, quote-unquote, standard of care. Now that we are, we expect that they're going to be deploying systems in these multiple locations, the four locations that I'd mentioned before, and build out a full program. The patient on their journey through their care with their cancer, they're not gonna always be at the same spot. They're not gonna be there at the right time. It's important that you place these systems that map to the patient journey.
Our job in transforming our customer support team into a customer success team is ensuring that as we build these bigger programs, if they're complex and our customers are gonna need a lot of help, that we stay very coordinated as a company and that we're helping them build these programs, maximize utilization, and continue to remain very happy with the technology. I hope that answers the question. It's a little bit different than what you'd asked because the way that we operate is a little bit different than what you suggested.
No, no, that's fine. If I can just summarize, you've got a sales team that's out there basically responsible for getting new placements in new sites or new placements in existing sites, and a customer success team that's responsibility is to make it easy for customers to have a lot more tests being done. Right now you're not too worried about charging for the number of tests. You're more worried about getting the activity happening. That will build opportunity for more revenue over time.
In summary, you got it.
Okay. Can I also just ask about, with the wind down of the clinical business, has there been any spin-off of business from facilities involved in the AstraZeneca trial?
No, there has not materially. A lot of these sites are international, and we've maintained our focus on the U.S. It has given us access to additional sites in the U.S., including getting some of the IT, legal, and BAA pieces behind us. That's the primary benefit that we're seeing there, that now we have more additional sites of service that we can go after at a faster pace. The international ones we have not focused on spinning off.
Okay, Tim, that actually leads into my next question. Final question is, can you just give me an update on what's happening internationally? I think you've got distributors set up in certain countries. Just wondering what's happening outside of the US.
Yeah. We have a pretty solid penetration rate in terms of our lymphedema business in Australia, primarily the Australia-New Zealand region. We'll continue to work away at that. Our primary focus is the U.S. market and the numbers that you saw in terms of our addressable market. I mean, it's With the news on NCCN guidelines and what this means for the company, that's going to remain our primary focus area. We'll be opportunistic in other areas in Europe and the Asia Pacific region as opportunities present themselves. It'll be just that, opportunistic until we have a strong penetration rate in the U.S.
I understand that, but do you have distribution in place, say in Europe, so that if people in Europe get excited by what's happening in the U.S. and want to take advantage of the technology?
Yep. Yeah. The complexities of the data play in Europe are still things that we need to work through that before we really address that market in a material manner. There's work to be done, before we get overly excited, but there will be a natural, you know, we'll be grabbing, I'm sure, some attention based on the NCCN guidelines, but that's a few years down the road for us.
Yep. No, that's fine. No, thanks very much.
Yeah.
I'll just add, by the way. Thank you, Peter. I'll add that with the remaining NCCN institutions, the remaining, top IDNs, remaining top cancer centers, that has to be our company's focus. As mentioned, this is our business to win or lose right now. We have the only technology that can serve the guidelines. We need to get in and lock down every single one of those and begin building programs. That's a lot of work, and it's a lot of work for a company that really doesn't have capacity to currently be a scaled organization to deliver on that.
A lot of things have to change and, but the great news is that the opportunity is right there in front of us, right in the U.S. market and, we'll get to other markets down the road, but it would be a shame if we let this opportunity pass that's presented to us now with the updated guidelines. Next question.
Thank you. Your next question comes from Hamish Jones from Bell Potter Securities Limited. Please go ahead.
Hey there, guys. I guess I'm quite interested in understanding your thoughts on kind of the timing and the kind of the evidence you'd expect to see in the performance of the business before you kind of start to take a more aggressive approach in terms of the investments and your overheads and what you call preparing for operational scale. When are you kind of, what do you need to see before you kind of start to press the button on kind of, you know, making those investments? Obviously that kind of goes against your other goal that you've communicated to the market of, you know, achieving breakeven. It's kind of a bit of a...
You can kind of see, you can see a time where you know, it could become highly advantageous to kind of actually, you know, invest significant amounts of money in some of these, you know, functions to take advantage of the opportunity. Just trying to understand how you see that kind of playing out, what's kind of changed from, you know, the current regime, to kind of really making the most of the opportunities, and investing to do that.
Yeah. It's the question of the day, to be frank. We didn't expect that when I was planning this trip, well before the 24th of March, I was planning a very different type of trip. I didn't expect that the guidelines would be in, and I was worried that we may not make it this year in the guidelines. The fact that we not only were included in the guidelines, but we were included in survivorship, which is every cancer patient at risk of lymphedema, and the fact that 45 of the 63 payers in the U.S. are doing medical policy reviews, 42 off cycle, tells me that this is gonna go a lot faster than any of us had anticipated. I have to tell you, this is very unusual. What's happened here is not typical.
It happens sometimes in the drug world, but in, in therapies or in the device world, it's really unusual that you have a condition like lymphedema that's been around forever, that really didn't have any sort of means of measuring to avoid it becoming a chronic condition. You had tape measure, but it was very ineffective and not used very often. Having something like this brand new to help prevent this horrible chronic condition and end up in the guidelines is really something that. Is rare, very rare. A lot of the people we're working with, including our head of reimbursement, who came to us from from a consulting firm by the name of MCRA, which is the best reimbursement consulting firm in the country, in the U.S.
She's been with us now for a few years, but in all of her time, she's never seen anything like this. It's when I say that we're surprised, it's because there isn't a lot of data points that we can refer to, comparisons of this having happened before. We have some thinking to do about just that because we may already be at that point where we need to really consider investing more heavily to take advantage of this opportunity. 'Cause once again, it's ours to win or lose. There's nobody else that can take advantage of this than our company. Excuse me. Providers are gonna wanna provide care under the guidelines.
Got it. Simply review and just let you know how it develops, but it's a kind of under a present consideration.
Right.
Okay. That's great. Thank you.
Thank you.
Thank you. Please note that we have got about five minutes left. Your next question comes from Ian Hyde, from Private Investor. Please go ahead.
Yeah, good morning, gents. just quickly about the 45 insurers that are looking at reviewing the policies. Will they actually notify you when they've changed their policy? If so, I assume then you'll be advising the markets. If you can just explain that one. thanks.
Yeah, that will become public record. What they have to do is in advance of making the policy change, they have to publicly post the medical policy. We'll be working directly with all of them, helping them craft their medical policy change. They won't necessarily take our input in all cases, but they'll look to us for some help. Also in making sure that if they're going beyond modality, but naming examples of the types of companies that would fall under that, we wanna make sure that they're not picking up companies that aren't truly bioimpedance spectroscopy. 'Cause there's some out there who are gonna try and take advantage of that reimbursement code. We'll be working with them on that.
Ultimately, they'll have to publish, and they have to give 30 days for people to give feedback on the on the policy change. The world will know as they publish, and we'll be able to report out on that as well. 30 days after that, it will become their policy.
Sure. Okay, thanks. Tim, with the new guidelines and what you've talked about for the monthly device costs, how many is the magic number so the company can then get to break even now, please?
The goals remain the same. It's still that 250 number to 300 in the midterm at 2,500. The good news is the pace at which we can get to that has now increased with NCCN guidelines. Obviously it's just gonna come down to what additional investments we make to accelerate the business that might drive that number higher. It'll be an equal scale of speed of adoption with investment into the business. Effectively, that 250-300 range stays the same.
Cool.
Keep in mind, Ian, that we have a whole bunch of accounts that are in the pipeline that have contracts that we've already put out there with pricing. We've put out notice to the sales team to share with those prospects that that will be good through the end of our fiscal year, then we'll be reproposing pricing at that point. That's why you're not gonna see an immediate change in the unit count or the system count.
Cool. Thank you.
You bet. Thank you.
Thank you. Your next question comes from Miriam Lee, from Private Investor. Please go ahead.
Well, hopefully, I wanna get a few more minutes on top of the hour. It was advertised as being an hour and a half. Anyway. Yeah. Look, I'll ask the big one that obsessed me and worried me the most, which is relating to competition. There are some other bioimpedance spectroscopy devices, one made in the Isle of Man, I think. Now, is there any chance that they could apply and get FDA clearance? I know they won't have done the huge PREVENT trial, but neither had ImpediMed when ImpediMed got the clearance in 2018. You know, are you monitoring people who are, I mean, other companies who might be putting in requests to have their devices cleared?
Are you able to monitor them, or do you only find out about that afterwards?
No. We are on top of our competitive landscape and tracking. We actually have in the appendix of our of the presentation that we have today, a little bit more detail around some of the competitive solutions there. There's a lot of work that needs to be done, and on the left-hand side of that document, it shows all of the steps that need to be taken to get to a point where you're not only FDA cleared, but you meet the you've got data that shows that your device will work for breast cancer patients and other patients, other cancer patients. That means a very large study that takes a lot of time, and it certainly could be done.
That's why we're really having to think about how quickly we wanna lead into this and invest and make sure we lock down as much of the market as possible. We have a big lead, but any time you have something like this happen, a change like this occur, there are going to be companies that are going to covet this market and gonna wanna find a way in as well. There could be some very large companies that just decide they're gonna throw a bunch of money at it and try and catch up to us. If we really lean in hard now, given the number of accounts that we already have in the key cancer institutes around the country, we can get there fairly quickly and lock down the rest of them and create a protective moat around our business.
Once you've got in and they've changed their workflow to address that specific solution, it's pretty difficult for someone to come in and unseat you, especially if there's a really good economic model for them, an ROI model, which there is.
Right. The other thing is that other devices which go under the name of bioelectrical impedance analysis devices, they're not actually the spectroscopy one. I mean, I'm actually talking about one called InBody, which apparently in certain places in Asia, Korea, for example, are being used for lymphedema and nephrology. Anyway, is there a difference in the way that they are used? I think it had to do with the initial resistance, one being related to algorithms, bringing it back to zero, and one being just a very low resistance. Am I on the right track and has the FDA made that difference?
You're on the right track. The FDA absolutely knows the difference between the two. What we have to make sure is that the insurance companies, the payers know the distinction, because that's where companies like InBody, with the InBody solution can try and take advantage of the CPT code, if the payer isn't really smart on the distinctions between the technology. That's another part of the solution here that we're going after when we're communicating with the insurance companies around their medical policy changes, including when they publish. You know, we'll try and get to them before then, but by the time they publish the policy for feedback, we will be weighing in on making sure that they're really clear that it's only bioimpedance spectroscopy and that if by chance they're naming...
Sometimes they will name a handful of solutions that fit the bill. If they're naming some of these companies, we'll make sure that they understand that is not bioimpedance spectroscopy. Because there is no one else in the world right now that is FDA cleared to monitor for bioimpedance or for lymphedema using bioimpedance spectroscopy. We're it.
Delfin, of course, uses the tissue dielectric constant or something like that. Anyway, which isn't the same thing. Apparently it is FDA cleared, but it doesn't have the code for claiming. Of course it hasn't been mentioned in the NCCN guidelines. At the moment it's hardly. I mean, am I right about those two things that I've said? It looks as though it's not really a significant competitor.
Yeah, you're spot on.
You're spot on. Those are the two that we think might try or might perceive themselves as fitting under that CPT code, but they don't.
Right. Well, that's all very reassuring. Do I have time for another couple?
We're gonna have to wrap up here, but, you know, we're happy to take a call with you separately.
Yeah, Miriam, I'd love to set up some more time where we can go through this individually as well to make sure all of your questions are answered.
Okay. Well, thanks for that. Thank you so much for a really full, complete, coverage, in that session, which really answered a lot of my questions. So... I'm sure a lot of everybody's questions.
Great. I'll be reaching out to you.
Thanks for your questions again.
Thank you. I'll now hand back for closing remarks.
Well, thank you again, everybody, for participating today. Really appreciate the great questions as well. A lot going on here, as you can imagine, and we're a very different company than we were on March 24th. Got a lot of work to do. We're gonna be here for the rest of the week in Australia and meeting with other shareholders and we look forward to those meetings. Hopefully, we'll be meeting a number of you that are still on the call in person before the end of the week and thank you. No more. Anything from you, Tim?
That's it. Thank you. Bye.
That is from our conference for today. Thank you for participating. You may now disconnect.